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Clinical Investigations: EsophagusGastroesophageal Reflux-induced Bronchoconstriction: An Intraesophageal Acid Infusion Study Using State-of-the-Art Technology
Section snippets
Subjects
Forty-seven adult subjects participated in this prospective study approved by the Human Use Committee at the University of Alabama at Birmingham on March 14,1990. Four groups were studied: (1) asthmatics with gastroesophageal reflux disease (AR), 20 patients; (2) asthmatics without gastroesophageal reflux disease (A), 7 patients; (3) gastroesophageal reflux disease only (R), 10 patients; and (4) normal controls (NC), 10 patients. All patients had a thorough history, baseline pulmonary function
Demographics of Patient Groups
Twenty patients with asthma and gastroesophageal reflux (AR) participated. The mean age was 43.3 years. The mean length of asthma symptoms was 13.5 years (range, 1 to 32 years). Seventy percent had nocturnal asthma symptoms, and 10 percent were smokers at one point in time. All patients were receiving β2-agonists, 40 percent were receiving prednisone, 35 percent were receiving inhaled steroids, 20 percent were receiving inhaled cromolyn sodium, 30 percent were receiving inhaled ipratropium
Pulmonary Function Response to Esophageal Acid Infusion
Baseline pulmonary spirometry and airway resistance were performed prior to intraesophageal infusions. There was no significant difference in the PFTs measured before feeding tube placement and those measured after tube placement. Therefore, PFTs performed after feeding tube placement were used as the baseline values in subsequent analyses.
Figure 2 shows the results of the ANCOVA for PEF. There was a significant main effect of subject group (p<0.014) in which, across all treatment phases, the
Discussion
This prospective study is the largest to date (and to our knowledge) assessing potential mechanisms of GER-related asthma using state-of-the-art esophageal and pulmonary methodology. We found that intraesophageal acid is associated with an impairment of PEF in all four groups of subjects, including NC.
Our results agree with a recent study by Wright et al9 in which intraesophageal acid infusions in 136 patients produced a decrease in FEV1 independent of the presence of pulmonary symptoms. This
ACKNOWLEDGMENTS
The authors thank Dr. William C. Bailey for reviewing an early version of this manuscript, Dr. Andrea Miksa who was involved during the planning stages, Dr. Arthur E. Euler of Glaxo Inc for his intellectual and financial support, and Ms. Cynthia Tate for her invaluable assistance in editing this manuscript.
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Cited by (0)
Supported in part by Glaxo, Inc.; NIH Physician Scientist Award, National Heart Lung Blood Institute, grant Kll-ML02195 (Dr. Harding); and National Institute of Digestive Disease and Kidney Disorder, grant RO1-DK40490-OIAI (Drs. Richter and Bradley).
Presented at Digestive Disease Week, American Gastroenterological Association, May 11, 1992, San Francisco.